The impact of translated reminder letters and phone calls on mammography screening booking rates: Two randomised controlled trials

Autoři: Alison Beauchamp aff001;  Mohammadreza Mohebbi aff005;  Annie Cooper aff006;  Vicki Pridmore aff006;  Patricia Livingston aff003;  Matthew Scanlon aff006;  Melissa Davis aff006;  Jonathan O’Hara aff003;  Richard Osborne aff003
Působiště autorů: Department of Medicine–Western Health, University of Melbourne, Melbourne, Australia aff001;  Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia aff002;  Faculty of Health, Deakin University, Geelong, Australia aff003;  Monash Rural Health, Warragul, Australia aff004;  Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia aff005;  BreastScreen Victoria, Melbourne, Australia aff006;  Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



Participation in mammographic screening for breast cancer in Australia is approximately 54% among the general population, but screening among women from some culturally and linguistically diverse (CALD) backgrounds is lower. BreastScreen Victoria apply strategies to increase screening including reminder letters and phone calls; however, these are usually provided in English. Using intervention strategies generated from the Ophelia (OPtimise HEalth LIteracy and Access) community co-design process, translated mammography reminder letters and in-language phone calls were tested within two randomised control trials (RCTs).

Methods and analysis

Women aged 50–75 years who were due for their 2-yearly screening mammography (for RCT#1) or were under-screened, i.e. ≥27 months since last screen (for RCT#2) were randomised into intervention or control groups. RCT#1 compared sending women routine reminder letters (English only) with translated (Arabic or Italian) letters. RCT#2 compared reminder telephone calls to women in their preferred language (Arabic or Italian) to no telephone call. The primary outcome for each trial was screening booking rates within 14-days. Primary outcomes were tested using Pearson’s chi-square test. Rates within language group (incidence ratio: IR) were compared using the Cochran-Mantel-Haenszel test.


For RCT#1 (letters) 1,032 women were randomised into the intervention arm or to usual care. Uptake of screening bookings was similar between both groups, with no differences observed by language group. For RCT#2 (phone calls), 195 women were randomised to the intervention group or to usual care. Overall, 64.2% of women in the intervention arm and 6% in the control arm booked a screening appointment within 14 days (p<0.0001). The IR (95%CI) of booking was 10.1 (3.9, 26.3) times higher among Italian women, and 11.6 (2.9, 46.5) times higher among Arabic women in the intervention compared to usual care groups.

Discussion and conclusion

A service improvement initiative derived from community members and breast screen providers was found to be highly effective. This evidence informed the service provider, BreastScreen Victoria, who have implemented these improvements into routine practice to improve screening among CALD groups and reduce health inequalities.

Klíčová slova:

Arabic people – Australia – Breast cancer – Cancer screening – Italian people – Language – Mammography – Telephones


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